One of the ironies of the Affordable Health Care Act is that many of the newly insured are discovering that their deductibles and co-insurance costs make it too expensive to use when a medical need arises.

Of the approximately 8 million enrollees through the Federal Website,17% picked the lower monthly cost Bronze Plans.  Although the monthly premium is less than other plans, the out of pocket cost are substantially higher and place an unaffordable burden on lower income individuals and families.  When combined with an HSA though an employer, the bronze plans becomes a viable choice, but it is important that you counsel your clients to insure they understand the potential cost of buying bronze.

 

 

For quotes and information, contact Heather Ainsworth

Be Careful When Writing Temp Policies

Your client loses their health insurance coverage due to a change in job or divorce.  They may be eligible for Cobra or State Continuation but the premiums are much higher than a Temporary Policy.  Before you offer this alternative be aware that the termination of an in between policy due to it's contract length could leave your client without coverage and ineligible to sign up for a qualified policy either in or outside of the exchange.  Several of the carriers that we have contacted indicated that the loss of a temporary policy is not considered a "qualifying event" under the law anyone in that situation would have to wait until the next open enrollment period to apply for coverage.

 

Emergency Room Use Increases Since ACA

 

It was supposed to head in the opposite direction, but after the Affordable Care Act took effect in January, emergency room use has spiked significantly in many hospitals.

In Louisville Kentucky,  a 12 percent spike in the number of patients — many of whom aren't actually facing true emergencies — is spurring one major  hospital to convert a waiting room into more exam rooms.

"We're seeing patients who probably should be seen at our (immediate-care centers)," said Lewis Perkins, the hospital's vice president of patient care and chief nursing officer. "And we're seeing this across the system."

That's just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, hospitals nationwide are seeing many of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years.

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won't accept Medicaid. And poor people often can't take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.

Plus, some patients who have been uninsured for years don't have regular doctors and are accustomed to using ERs, even though it is much more expensive.

"It's a perfect storm here," said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group. "We've given people an ATM card in a town with no ATMs."

 

 

The Need For Community Health Clinics

 

The Department of Health and Human Services has reported just over 8 million people have enrolled under ACA.  That’s only 2.5 percent of the total U.S. population—and recent estimates put the total number of uninsured at close to 50 million, or 15.8 percent. The federal Health Resources and Services Administration estimates that 60 million Americans live in areas without enough primary care physicians. Scarier still is that the U.S. population is growing, and aging, and the demand for primary care is expected to grow by about 17 percent in the next decade.

“There is this long-term time bomb ticking because there are lots of places across the U.S.—a fifth of the country live in what’s called primary care shortage areas—where there aren’t enough primary care doctors,” says Dr. Leighton Ku, the director of George Washington University’s Center for Health Policy Research and lead author of the recent study. “In recent years, the U.S. has not been turning out enough primary care doctors.”

That’s why community health centers are so essential. Millions of people don’t get to see primary care doctors working in offices with comfortable waiting rooms. They go to community health centers, which serve all patients, regardless of their ability to pay, and which, as a result, rely heavily on a separate and much less well-known piece of the ACA.

Health centers of this kind are defined and governed by Section 330 of an old piece of legislation, the Public Health Service Act, signed into law by President Franklin Roosevelt in 1944. In it, they are called “grant-supported federally qualified health centers.”

These are typically “primary care clinics that specialize in serving needy patients,” says Ku. “Those are dominantly uninsured people and people on Medicaid. But it does vary—for example, in rural areas, in many cases a community health center is the only health care provider in town, so it serves everyone.”

And it’s not just rural areas, either. There may be plenty of private doctors’ offices in Manhattan, Ku points out, but maybe not so many in the Bronx. “So even if you have an insurance card that says you’re eligible, you can’t find an office that’s convenient, so you go to the community health center.”

These health centers are sometimes called the “safety net” of the country’s health care system because they catch the poor, the uninsured, the formerly incarcerated and those living in rural (and usually medically underserved) areas.  After state health care reform was passed in Massachusetts in 2006, wait times and lists for seeing primary care doctors shot up—so community health centers stepped up and filled that gap.

They can provide basic care, but they can also provide much more specialized care (or at least identify serious problems and direct patients to the appropriate next steps). For example, many people just getting out of prisons—a subset of the population that has significantly higher rates of many serious illnesses like mental health disorders and HIV—go to community health centers.

These community health centers save lives. But perhaps just as important they also save dollars.

A 2013 California report showed that 90 percent of prisoners had no health care upon release from incarceration. The formerly incarcerated end up discontinuing their meds, delay seeing primary care doctors (out of concern for costs) and, as a result, end up in emergency rooms—where high treatment costs are passed on to everyone else via insurance premiums. Health centers can be the solution.

One example is the Transitions Clinic formed in 2006. Operating in a number of locations across the country, it is a community health center that puts patients into the immediate care of a health care provider. The results are encouraging: Those who had gone through the clinic had 50 percent fewer ER visits than those who didn’t.

In a recent patient study that compared patients who received care at community health centers with others who did not—controlling for all other factors—it was found that health center patients had medical expenditures about one-quarter less than their peers.

That’s one big reason that, historically, the federal government has wanted these centers to stay funded and operational. In Congress traditionally there has been bipartisan support for the centers throughout history. “The Bush administration said they wanted to double their numbers. The Obama administration, with the ACA, pumped extra money in.”

But as with any government program, the problem is funding. Community health centers are primarily funded through two avenues. The first is Medicaid, the health care program for low-income families and individuals, which will pay out claims generated by patients at the centers. Then there are the grants—some state, local or private, but most federal, and most coming specifically from the federal Bureau of Primary Health Care, which has $11 billion in mandatory funding as a result of the ACA.

According to the study, “These grants comprise the ‘core’ funding for community health centers, helping to provide access to uninsured patients, as well as supporting infrastructure and administrative costs and other critical services.”

If the grant money disappears, so will the centers.

In 2012 (the last year exact numbers were reported), there were approximately 1,200 grantees, operating 9,000 community health center locations serving 21.1 million patients. The recent Milken Institute study projects that with current funding levels, combined with Medicaid expansion, that number will increase to 25.6 million patients in 2014. That’s actually great news—it means more Americans are seeing doctors and likely staying healthier.

But the problem is that the mandatory funding will expire after September 30, 2015, unless legislators act to renew the appropriation.

There is major concern by those involved in the operation of community clinics that continued funding could disappear and given the current budget environment.

If it does, we won’t just claw back to 2012 numbers. We’ll go well beyond them. One study projects that if health centers lose their funding (and no additional states do the Medicaid expansion), health center capacity would drop to 18.8 million by 2020. The reduction, says the study, “is roughly equivalent to the population of the state of Arizona, or the combined populations of Los Angeles, California and Houston, Texas.”

On the other hand, if the funding is renewed, capacity could increase all the way to 36.1 million by 2020, according to the Milken Institute projections. That’s over 10 million more patients getting the care they need.

 

 

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